TY - JOUR
T1 - Younger haploidentical donor versus older matched unrelated donor for patients with AML/MDS
AU - Marcoux, Curtis
AU - Marin, David
AU - Ramdial, Jeremy
AU - AlAtrash, Gheath
AU - Alousi, Amin M.
AU - Oran, Betul
AU - Kebriaei, Partow
AU - Popat, Uday R.
AU - Rezvani, Katayoun
AU - Champlin, Richard E.
AU - Shpall, Elizabeth J.
AU - Mehta, Rohtesh S.
N1 - Publisher Copyright:
© 2023 Wiley Periodicals LLC.
PY - 2023/5
Y1 - 2023/5
N2 - Optimal donor selection is fundamental to successful allogeneic hematopoietic cell transplantation (HCT), and donor age influences survival after both matched unrelated donor (MUD) and haploidentical donor HCT. Though recent studies have shown similar outcomes between MUD and haploidentical HCT, it is unknown if outcomes differ following HCT with younger haploidentical donors compared to HCT with older MUDs. Therefore, we performed a retrospective analysis comparing outcomes of myelodysplastic syndrome (MDS) and acute myeloid leukemia (AML) patients who underwent HCT with younger (≤35 years) haploidentical donors (n = 494) or older (>35 years) MUDs (n = 1005). Patients in the haploidentical and MUD groups received post-transplant cyclophosphamide (PTCy) and conventional graft-versus-host-disease (GVHD) prophylaxis, respectively. In multivariate analysis, use of younger haploidentical donors was associated with improved overall survival (hazard ratio [HR] 0.81, 95% confidence interval [CI] 0.69–0.95, p =.01) and lower rates of grade II-IV acute GVHD (HR 0.64, 95% CI 0.53–0.77, p <.001), grade III-IV acute GVHD (HR 0.37, 95% CI 0.25–0.53, p <.001), and chronic GVHD (HR 0.49, 95% CI 0.40–0.60, p <.001). Relapse rates were similar among those who received myeloablative conditioning but were higher in patients of the younger haploidentical group who received reduced intensity conditioning (HR 1.49, 95%CI 1.18–1.88, p =.001). The younger haploidentical group had significantly lower non-relapse mortality ≥3 months post-HCT (HR 0.59, 95% CI 0.38–0.90, p =.02). Our data support the use of younger haploidentical donors with PTCy over older MUDs with conventional prophylaxis in patients with MDS or AML. Further studies on the importance of donor age in haploidentical and MUD HCT with PTCy prophylaxis are warranted.
AB - Optimal donor selection is fundamental to successful allogeneic hematopoietic cell transplantation (HCT), and donor age influences survival after both matched unrelated donor (MUD) and haploidentical donor HCT. Though recent studies have shown similar outcomes between MUD and haploidentical HCT, it is unknown if outcomes differ following HCT with younger haploidentical donors compared to HCT with older MUDs. Therefore, we performed a retrospective analysis comparing outcomes of myelodysplastic syndrome (MDS) and acute myeloid leukemia (AML) patients who underwent HCT with younger (≤35 years) haploidentical donors (n = 494) or older (>35 years) MUDs (n = 1005). Patients in the haploidentical and MUD groups received post-transplant cyclophosphamide (PTCy) and conventional graft-versus-host-disease (GVHD) prophylaxis, respectively. In multivariate analysis, use of younger haploidentical donors was associated with improved overall survival (hazard ratio [HR] 0.81, 95% confidence interval [CI] 0.69–0.95, p =.01) and lower rates of grade II-IV acute GVHD (HR 0.64, 95% CI 0.53–0.77, p <.001), grade III-IV acute GVHD (HR 0.37, 95% CI 0.25–0.53, p <.001), and chronic GVHD (HR 0.49, 95% CI 0.40–0.60, p <.001). Relapse rates were similar among those who received myeloablative conditioning but were higher in patients of the younger haploidentical group who received reduced intensity conditioning (HR 1.49, 95%CI 1.18–1.88, p =.001). The younger haploidentical group had significantly lower non-relapse mortality ≥3 months post-HCT (HR 0.59, 95% CI 0.38–0.90, p =.02). Our data support the use of younger haploidentical donors with PTCy over older MUDs with conventional prophylaxis in patients with MDS or AML. Further studies on the importance of donor age in haploidentical and MUD HCT with PTCy prophylaxis are warranted.
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U2 - 10.1002/ajh.26870
DO - 10.1002/ajh.26870
M3 - Article
C2 - 36734029
AN - SCOPUS:85148035343
SN - 0361-8609
VL - 98
SP - 712
EP - 719
JO - American journal of hematology
JF - American journal of hematology
IS - 5
ER -